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Encouraging Picky Eaters with Autism to Try New Foods

November 9, 2012

This week’s “Got Questions?” answer comes from Emily Kuschner, PhD, a clinical psychologist at the Children’s Hospital of Philadelphia, a center within Autism Speaks Autism Treatment Network. Dr. Kuschner works within the hospital’s Lurie Family Foundation’s MEG Imaging Center, its Department of Radiology and its Center for Autism Research. With support from an Autism Speaks research grant, Dr. Kuschner is developing and testing a cognitive behavioral treatment program that addresses the complex reasons behind picky eating in individuals with ASD.

My grandson is turning five and eats only a handful of foods. What can we do to get him to try new foods?

If your child or grandchild is a picky eater, know that you’re not alone. Up to 70 percent of parents with children on the autism spectrum report problems with excessively narrow eating habits. Often, these tendencies continue into adolescence and adulthood.

Researchers are still trying to fully understand what causes picky eating in many of those with autism and how to intervene to expand food choices. Our new Autism Speaks research project focuses on expanding food choices by addressing underlying anxiety, inflexibility and sensory issues. This new project focuses on older children and adolescents, whose eating habits and aversions have received less attention.

Here are some strategies parents can use to diversify a narrow diet – no matter the child’s age.

First and foremost, it’s important to rule out any medical drivers or food allergies that could be causing a dislike of particular flavors or food groups. Children may avoid particular foods because they upset their stomachs. However, they may not be able to describe or identify this connection. Consult your pediatrician to investigate possible allergies or complicating medical conditions before starting any new food regime.

Also, it’s perfectly natural for a child to be averse to eating a food that caused a bad tummy ache or a bout of food poisoning in the past. That’s basic instinct!

Once you confirm that medical issues aren’t behind a child’s picky eating, you should keep one basic rule in mind: Avoid making food a source of conflict within your family.

It is very common for picky eating to lead to dinner table arguments and battles of will between children and parents, grandparents or other caregivers. Arguing or trying to force a child to eat usually makes the situation worse. Instead, take a moment to think creatively and try to explore the possible causes behind your child’s dislike of new or particular foods.

For example, many children with autism dislike trying new things. In psychology, we call this neophobia. If a child seems afraid or wary of new foods, think of ways to manage this anxiety.

For example, instead of asking the child to taste the new food outright, try a stepwise approach. First, you can simply look at the new food together. From there, you could suggest that the two of you smell it and/or touch it. These are great opportunities for playing games and having fun with food. (See some options at the end of this post!) When you feel your grandchild is ready, suggest licking or tasting the food.

Sometimes it helps to have a child mix the new food with a familiar and preferred food for this first taste. We’ve seen this gradual approach decrease anxiety about new foods by increasing familiarity.

It’s also important to give children as many choices as possible so they can feel in control of their meals. For example, say you want your grandchild to eat a vegetable at dinner. Instead of demanding that he eat peas, give him three choices: peas, carrots or salad. Similarly, you can present a wide array of food options at mealtime, and then invite your grandchild to choose three foods to put on his plate. This approach also helps children know that it’s okay to have preferences around food (we all have at least one food we don’t like to eat!), but that variety in diet is still important.

Along the same lines, if you’re making your grandchild’s favorite macaroni and cheese for dinner, tell him that tonight he should add one mystery ingredient for other family members to guess or discover during the meal. He gets to choose: turkey, broccoli or tomatoes? Encouraging choice and control within a defined window can help avoid arguments, tears and meltdowns at the dinner table. At the same time, it encourages a more varied and well-formed diet.

Finally, some kids on the autism spectrum have sensory difficulties with food that go beyond flavor. For example, a child may dislike the way a cherry tomato turns from solid to squishy in her mouth, though she likes the flavor. It can be difficult for children to separate out that good taste from the disturbing texture. If this is one of your grandchild’s issues, explore creative solutions for managing the sensory concern. It may help the child to smash the tomatoes before eating it (So it doesn’t explode!) or blend foods together to even out their textures.

Admittedly the sources of food aversions can be difficult to identify. Certainly, a distressed 5-year-old can have a hard time understanding and describing what is bothering him about a particular food.

One pitfall I see many parents succumbing to is the reward system. Yes, the age-old “if you eat your broccoli, you can have ice cream.” Though this trick may work as a quick fix, it won’t produce the desired results in the long run. Your child may choke down the broccoli to get the reward, but this plan is not likely to increase his preference for eating broccoli. Instead, we want kids to enjoy new foods and form more flexible, healthy eating habits.

So it’s important to help him find solutions. Most importantly, the more fun, the better! Bowl with watermelons. Make faces on pizzas with vegetables or pepperoni. Paint with pasta sauce. Experiment with how ingredients change color or consistency when mixed together. Each of these activities will help a child become more comfortable around new and different foods, create opportunities for trying new tastes and keep food discussions positive. Make mealtime an opportunity for flexibility, education, choices and – most of all – fun, and children will likely respond favorably, whatever their ages.

This is one time that it’s okay to play with your food!

If you’re interested in learning more about autism research at the Children’s Hospital of Philadelphia, I’d like to invite you to browse open studies at www.AutismMatch.org. You may also contact the following research labs for further information: